[Effect of resection of adenoids and/or tonsil on the immune indexes in children with obstructive sleep apnea hypopnea syndrome].

Objective: To study the effect on immune indexes in children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after resection of adenoid and/or tonsil. Methods: A total of 100 children with OSAHS due to adenoid hypertrophy were enrolled in Department of Otorhinolaryngology Head and Neck Surgery, the Second Hospital of Dalian Medical University from December 2016 to December 2018. Some cases were complicated with tonsil hypertrophy or chronic tonsillitis. 6 ml of fasting peripheral venous blood were collected from all subjects at the 1st day before surgery, 4th day, 1 month, 3 months and 6 months after surgery to detect lymphoid subsets percentage (CD3(+), CD4(+),CD8(+), CD4/CD8, CD19, NK) and level of immunoglobulin (IgG, IgA, IgM). Grouping: group A was a total of 51 cases with adenoid hypertrophy after Adenoid plasma ablation; group B was a total of 27 cases with adenoid hypertrophy and chronic tonsillitis after plasma ablation of adenoid and tonsil; and group C was a total of 22 cases hypertrophy of adenoid and tonsil after plasma ablation of adenoid and tonsil.In the baseline data, age, gender and other variables were analyzed by anova and chi-square test, repeated measurement anova was used for intra-group and inter-group comparison of observation indicators at different time points after operation, and independent sample t-test was used for comparison between the two groups at observation points 3 months after operation. Results: (1) In group A, the percentage of CD19 lymphocytes before surgery was higher than that at 4th day after surgery, and the difference was statistically significant (21.85±6.20 vs.19.18±5.91, P<0.05). The other immune indexes were not statistically different before and after surgery (P>0.05). (2) In group B, the percentage of CD19 lymphocytes, CD3(+)T lymphocytes, CD8(+)T lymphocytes and the level of IgG at 4th day after surgery were significantly different between those before surgery (all P<0.05). At the 1st month after surgery, the percentage of CD3(+)T lymphocytes, CD8(+)T lymphocytes, CD19 lymphocytes and the level of IgG were significantly different between those before surgery (all P<0.05). The other immune indexes were not statistically different before and after operation (P>0.05). (3) In group C, the percentage of CD19 lymphocytes and the CD3(+)T lymphocytes at 4th day after surgery were significantly different between those before surgery (all P<0.05).In the 1st month after surgery, the percentage of CD8(+)T lymphocytes and CD19 lymphocytes were significantly different between those before surgery (all P<0.05). The other immune indexes were not statistically different before and after operation (P>0.05). (4) Among three groups, the percentage of CD4(+)T lymphocytes, the levels of IgG and IgA before surgery between group A and Group B were statistically significant (all P<0.05). At 4th day after surgery, the percentage of CD4(+)T lymphocytes in group B and C were lower than those in group A, and the differences were statistically significant (32.22±6.14, 32.36±6.87 vs. 36.36±5.19, all P<0.05); the other immune indexes were not statistically different among each group before and after surgery (P>0.05). Conclusions: Resection of adenoid has no significant effect on the immune indexes in children with OSAHS. The children with OSAHS complicated with tonsil problems have immune index disorder before surgery. Surgery has a certain effect on the immune indexes of children with OSAHS in a short period of time, and tends to normal level after one month.目的： 研究切除腺样体和（或）扁桃体对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿免疫指标的影响。 方法： 本研究为前瞻性研究。选取2016年12月至2018年12月就诊于大连医科大学附属第二医院耳鼻咽喉科因腺样体肥大导致OSAHS的患儿共100例，部分患儿合并有扁桃体肥大或慢性扁桃体炎，男74例，女26例，年龄3~10岁，病程均>3个月。所有患儿分别于术前1 d及术后4 d、1个月、3个月、6个月晨起空腹采集外周静脉血6 ml，检测淋巴细胞亚群百分比（CD3(+)、CD4(+)、CD8(+)、CD4/CD8、CD19、NK）及免疫球蛋白（IgG、IgA、IgM）含量。分组：A组为单纯腺样体肥大，共51例，行腺样体等离子消融术；B组为腺样体肥大合并慢性扁桃体炎，共27例，行腺样体、扁桃体等离子消融术；C组为腺样体肥大合并扁桃体肥大，共22例，行腺样体、扁桃体等离子消融术。基线资料中年龄、性别等变量分别采用方差分析及卡方检验，术后不同时间点的观察指标的组内及组间比较采用重复测量方差分析，术后3个月访视点两组间比较采用独立样本t检验。 结果： A组：术后4 d时CD19淋巴细胞百分比高于术前，差异有统计学意义（21.85±6.20比19.18±5.91，P<0.05），其余免疫指标在术前、术后各时间点比较差异均无统计学意义。B组：术后4 d时，CD19淋巴细胞百分比高于术前，CD3(+)淋巴细胞百分比、CD8(+)淋巴细胞百分比、IgG含量均低于术前，差异均有统计学意义（P值均<0.05）。术后1个月时，CD3(+)淋巴细胞百分比、CD8(+)淋巴细胞百分比均高于术前，CD19淋巴细胞百分比、IgG含量均低于术前，差异均有统计学意义（P值均<0.05）。其余免疫指标在术前、术后各时间点比较差异均无统计学意义。C组：术后4 d时，CD19淋巴细胞百分比高于术前，CD3(+)淋巴细胞百分比低于术前，差异均有统计学意义（P值均<0.05)。术后1个月时，CD8(+)淋巴细胞百分比高于术前，CD19淋巴细胞百分比低于术前，差异均有统计学意义（P值均<0.05）。其余免疫指标在术前、术后各时间点比较差异均无统计学意义。三组间比较：术前A组CD4(+)淋巴细胞百分比含量高于B组，B组IgG、IgA含量高于A组，差异均有统计学意义（P值均<0.05）。术后4 d时，B、C组CD4(+)淋巴细胞百分比均低于A组，差异均有统计学意义（32.22±6.14、32.36±6.87比36.36±5.19，P值均<0.05）；其余各指标在术前、术后各时间点组间比较，差异均无统计学意义。 结论： 切除腺样体对OSAHS患儿免疫指标无明显影响，伴有扁桃体问题的OSAHS患儿术前存在免疫指标紊乱。手术对OSAHS患儿免疫指标短期内有一定影响，1个月后趋于正常水平。.